Aldosterone antagonists and other potassium-sparing diuretics (Formulary: Cardiovascular)

Important: Formulation and dosage details

Formulation:

Tablets 5mg

Dosage:

With other diuretics.
Congestive heart failure and hypertension, initially 5 to 10mg daily
Cirrhosis with ascites, initially 5mg daily.

Important: Formulation and dosage details

Formulation:

Oral solution 5mg/5mL

Dosage:

With other diuretics.
Congestive heart failure and hypertension, initially 5 to 10mg daily
Cirrhosis with ascites, initially 5mg daily.

Important: Formulation and dosage details

Formulation:

Tablets 25mg, 50mg (specialist initiation only)

Dosage:

Heart failure, initially 25mg once daily increased within 4 weeks to 50mg once daily.

Notes:

Patients who have suffered a myocardial infarction with left ventricular dysfunction (ejection fraction 40% or less) and either diabetes or clinical signs of heart failure should be considered for eplerenone unless contra-indicated by the presence of renal impairment or high potassium levels, refer to SIGN 147.  

Eplerenone should also be considered for patients with NYHA class II (chronic) heart failure and left ventricular dysfunction (ejection fraction 30% or less), refer to SMC 793/12.

Important: Formulation and dosage details

Formulation:

Tablets 10mg, 20mg (Restricted: specialist initiation only - care transferred to Primary Care once monitoring arrangements have been agreed). 

Dosage:

Indication: 

• SMC2486: For the treatment of chronic kidney disease (stage 3 and 4 with albuminuria) associated with type 2 diabetes in adults.

Place in therapy: 

• Additional add-on treatment to standard of care with ACE inhibitors or ARBs (at their highest tolerated doses) for patients with stage 3 or 4 chronic kidney disease with albuminuria and type 2 diabetes.
  In most cases it will be initiated after an SGLT2 inhibitor has been added to treatment and where a high residual risk as measured by UACR still exists.
• Where a patient has proven intolerance of, or is unsuitable for an SGLT2 inhibitor, finerenone may be considered on top of existing ACE or ARB treatment, as per NICE guidance.

Guideline: Finerenone in diabetic kidney disease (Guideline)

Notes: 

• Monitor requirements as per BNF/SPC.
• Provide patient with Medicines Sick Day Rules card and advice.
• Hyperkalaemia:
  • Initiation: Do not initiate treatment if serum-potassium >5mmol/L. 
  • During treatment: Withhold if serum-potassium increases to >5.5mmol/L.

Important: Formulation and dosage details

Formulation:

Tablets 25mg, 100mg

Dosage:

Heart failure, 25mg daily. 

Important: Formulation and dosage details

Formulation:

Oral suspension 25mg/5mL

Dosage:

Heart failure, 25mg daily. 

Notes:

Spironolactone 25mg daily has been shown to reduce mortality in patients with heart failure (NYHA II to IV) who are already receiving an ACE inhibitor and a diuretic and/or digoxin, refer to heart failure management guidance.

Spironolactone at higher doses is also indicated for ascites and primary hyperaldosteronism and is used fourth-line for hypertension [off-label]; see Hypertension (Guidelines) and SIGN 147.